Biomedical subjects

Maninder Kalra

Publications and source records attributed to Maninder Kalra.

11 recordsLinked to original sources

PubMed2006

Determination of respiratory phase during acquisition of airway cine MR images.

Subjects were imaged on a 1.5-T Signa MRI system using the head-neck vascular coil. An axial fast gradient echo cine, at the base of the second cervical vertebra, was obtained. A total of 128 images were acquired with a rapid image acquisition (one per second) over several respiratory cycles. The analog signal from the MR scanner (RF unblank) was utilized to determine the duration of the cine MR sequence. The phase of respiration was determined by analyzing the nasal air flow connected via pressure tubing to a pressure transducer outside the MR scanner room. We were thus able to determine the phase of respiration during acquisition of individual airway cine MR images. There was a wide range of airway volume measurements over the respiratory cycle with the lowest volume at end expiration and the highest at peak inspiration.

Adolescent↗

PubMed2006

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls.

BACKGROUND: Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. OBJECTIVE: To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. MATERIALS AND METHODS: Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. RESULTS: There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). CONCLUSIONS: Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome.

Adenoidectomy↗

PubMed2006

Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications.

OBJECTIVE: To determine, in a series of children younger than 6 years undergoing adenotonsillectomy for treatment of clinical obstructive sleep apnea syndrome (OSAS), the effect of age on prevalence of postoperative respiratory complications. The primary objective was to define a practice standard for postoperative hospital admission. DESIGN: Retrospective analysis. SETTING: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. PATIENTS: All children younger than 6 years who underwent adenotonsillectomy to treat OSAS from June 1, 1999, to May 31, 2001. MAIN OUTCOME MEASURES: The percentage of children younger than 3 years undergoing adenotonsillectomy to treat OSAS who experience a postoperative respiratory complication. RESULTS: Of 2315 patients younger than 6 years undergoing an adenotonsillectomy for treatment of OSAS, 149 (6.4%) developed a postoperative respiratory complication. Even though there was a lower incidence of comorbid medical conditions in this cohort, children younger than 3 years were at a greater risk for developing a postoperative respiratory complication compared with those aged 3 to 5 years (9.8% vs 4.9%, P<.001). Logistic regression analysis revealed that children younger than 3 years had a nearly 2-fold increased risk for respiratory complications postoperatively (odds ratio, 1.98; 95% confidence interval, 1.41-2.77) when controlling for race and sex. CONCLUSIONS: Adenotonsillectomy to treat OSAS is associated with a significantly higher rate of postoperative respiratory complication in children younger than 3 years compared with children aged 3 to 5 years. Our results support hospital admission for all patients younger than 3 years undergoing adenotonsillectomy for treatment of OSAS.

Adenoidectomy↗

PubMed2006

Effect of asthma on the risk of obstructive sleep apnea syndrome in atopic women.

BACKGROUND: Obstructive sleep apnea syndrome is associated with significant morbidity and remains underdiagnosed in women. Identification of high-risk groups among women is important for early detection and treatment. OBJECTIVE: To describe the prevalence of snoring in young women with atopy and to determine the risk factors for snoring in these individuals. METHODS: The Cincinnati Childhood Allergy and Air Pollution Study is an ongoing prospective birth cohort study of infants with at least 1 atopic parent. Mothers of study participants were evaluated by questionnaire for snoring, respiratory symptoms, and smoking status. Women who snored were compared with those who did not snore. Logistic regression analysis was performed to determine risk factors for snoring. RESULTS: Data were available on 677 women who had at least 1 live birth. Of these 677 women, 546 (81%) were white, 122 (18%) were African American, and 9 (1%) were biracial or Asian. The mean +/- SD age of the cohort at the time of evaluation for snoring was 29.6 +/- 5.6 years. Of the 677 women, 231 (34%) reported snoring at least 1 night per week, and snoring almost always (5-7 nights per week) was reported by 85 (13%). An almost 2-fold risk of snoring was associated with asthma (diagnosis and current symptoms) (odds ratio, 1.8; 95% confidence interval, 1.1-2.8) and African American race (odds ratio, 1.6; 95% confidence interval, 1.04-2.6) after controlling for income level and smoking status. CONCLUSIONS: We found a high prevalence of snoring inyoung women with atopy and a significant association with asthma.

Adult↗

PubMed2006

Atopy as a risk factor for habitual snoring at age 1 year.

STUDY OBJECTIVES: To determine the prevalence of habitual snoring (HS) in 1-year-old children, and to assess the relationship between HS and atopic status in these children. DESIGN: Cross-sectional evaluation of a birth cohort selected from the population. SETTING: Ohio and Kentucky River Valley communities. PARTICIPANTS: Children participating in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) were recruited for this study. MEASUREMENTS AND RESULTS: At age 1 year, the children were evaluated for atopic status and exposure to environmental tobacco smoke (ETS). Parents were asked to complete a questionnaire pertaining to their snoring frequency and that of their child. Children with HS (snoring three or more times per week) were compared to those who either did not snore or snored less than three times per week. Data were available on 681 of the 700 children participating in CCAAPS study. Of these 681 children (377 boys and 304 girls), 542 were white (80%), 118 were African American (17%), and 21 were biracial or Asian (3%). The mean age (+/- SD) of our cohort at the time of assessment for snoring was 13.7 +/- 2.6 months. Of the 681 children, 105 snored habitually (15%). There was a significant association between HS and the following: (1) positive atopic status (p = 0.005); (2) African-American race (p < 0.01); and (3) a history of snoring in the father (p < 0.01) or in the mother (p < 0.01). There was, however, no association between HS and ETS. CONCLUSIONS: We found a 15% prevalence of HS in 1-year-old children born to atopic parents and a significant association with positive atopic status.

Cohort Studies↗

PubMed2005

Left ventricular function in children with sleep-disordered breathing.

Severe obstructive sleep apnea in children leads to congestive heart failure. We studied the early changes in left ventricular function across a range of severity of the disorder. A dose-dependent decrease in diastolic function with increased severity of obstructive apnea was demonstrated.

Adolescent↗

PubMed2005

Asthma as a risk factor for respiratory complications after adenotonsillectomy in children with obstructive breathing during sleep.

BACKGROUND: Children with asthma are at increased risk for obstructive breathing during sleep. Adenotonsillectomy, the treatment of choice for obstructive breathing during sleep, is associated with significant postoperative respiratory morbidity. OBJECTIVE: To determine whether asthma is a risk factor for respiratory complications after adenotonsillectomy in children with obstructive breathing during sleep. METHODS: This case-control study compared 115 children aged 3 to 18 years with respiratory complications after adenotonsillectomy (study group) with 115 children without respiratory complications after adenotonsillectomy (control group). RESULTS: The postoperative respiratory complications ranged from oxygen desaturation to respiratory failure that required mechanical ventilation. The study group had a higher proportion of children with asthma (P < .01). Logistic regression analysis showed that asthma increases the odds of postoperative respiratory complications to 4.4 (95% confidence interval, 2.13-9.0), after controlling for age, weight greater than the 97th percentile for age, sex, race, and medical conditions other than asthma. CONCLUSIONS: In children with obstructive breathing during sleep, the presence of asthma is associated with an increased risk of respiratory complications after adenotonsillectomy.

Adenoidectomy↗

PubMed2005

Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery.

OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in extremely overweight adolescents and to examine the effect of significant weight loss on OSA severity. RESEARCH METHODS AND PROCEDURES: We reviewed the anthropometric and polysomnographic data on all extremely overweight adolescents who underwent laparoscopic Roux en Y gastric bypass surgery at Cincinnati Children's Hospital Medical Center from July 2001 to September 2004. Repeat polysomnograms were performed after significant weight loss. Comparisons were made between pre- and postoperative polysomnographic data. RESULTS: Nineteen of 34 patients (55%) who underwent bariatric surgery were diagnosed with OSA. Subsequent to surgery, 10 of these patients returned for follow-up polysomnographic testing. After significant weight loss (mean, 58 kg), OSA severity markedly decreased in all patients (median apnea-hypopnea index at baseline vs. after weight loss, 9.1 vs. 0.65). DISCUSSION: Our study indicated that OSA was highly prevalent in extremely overweight adolescents meeting eligibility criteria for bariatric surgery. The significant weight loss after gastric bypass was associated with a marked reduction in OSA severity.

Adolescent↗

PubMed2005

Pulmonary management of the patient with muscular dystrophy.

Pulmonary involvement is common in patients with muscular dystrophy, and routine screening for evidence of respiratory muscle dysfunction should be performed. Testing for respiratory muscle strength, as well as an assessment for sleep-disordered breathing, should be obtained in consultation with a specialist. Adequate airway clearance and correction of impaired ventilation are the key components of pulmonary management in this group of patients. Also, special emphasis on airway clearance is recommended during upper respiratory infections, as well as in the postoperative period. Early initiation of ventilatory support has been shown to result in longer life expectancy.

Child↗

PubMed2004

Structural cardiac changes as a predictor of respiratory complications after adenotonsillectomy for obstructive breathing during sleep in children.

BACKGROUND AND PURPOSE: To determine the association between structural cardiac changes and postoperative respiratory complications after adenotonsillectomy for obstructive breathing during sleep. PATIENTS AND METHODS: Forty-eight children, ages 2-18 years, undergoing adenotonsillectomy for obstructive breathing during sleep were recruited for this case control study. The case group consisted of 24 children with postoperative respiratory complications after adenotonsillectomy who also had an echocardiogram. An equal number of children without postoperative respiratory complications after adenotonsillectomy were recruited as controls. Left ventricular mass (LVM) was calculated from 2D guided M mode echocardiographic measurements of the left ventricle. Left ventricular mass index (LVMI) was calculated as left ventricular mass/height(2.7). Left ventricular hypertrophy (LVH) was defined as LVMI index greater than the 95th percentile for age. The two groups were compared for demographic variables and cardiac structure. RESULTS: The two groups did not significantly differ by age, height, gender or racial distribution. LVH and right ventricular (RV) dimension greater than the 95th percentile for age remained significantly associated with the occurrence of postoperative respiratory complications after controlling for body mass index (BMI) Z score, age, gender, race, systolic and diastolic blood pressure. CONCLUSIONS: The increased prevalence of structural cardiac changes in the group with complications (P<0.01) suggests an underlying cardiac origin for postoperative respiratory complications in this group of children.

Adenoidectomy↗

PubMed2004

Neuropsychological effects of pediatric obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a fairly common nocturnal breathing disorder, affecting 2-4% of individuals. Although OSA is associated with medical morbidity, its most functionally disruptive effects in adults appear to be neuropsychological in nature. Research on the neuropsychological effects of pediatric OSA has been limited. This study compared the neuropsychological functioning of school-aged children with OSA to that of healthy children. The primary goal was to clarify the presence and pattern of neuropsychological morbidity associated with pediatric OSA. Sleep was assessed with parent-report questionnaires and laboratory sleep studies. Neuropsychological functioning was assessed by formal tests and parent- and teacher-report questionnaires. Data indicated OSA-related cognitive and behavioral impairment that was particularly marked on measures of behavior regulation and some aspects of attention and executive functioning. Minimal effects were observed on measures of intelligence, verbal memory, or processing speed. Exploratory analyses failed to indicate any clear relationship between neuropsychological functioning and objective indexes of hypoxia or sleep disruption, though the sample was small. These data add to a growing literature which suggests that significant neuropsychological deficits are associated with pediatric OSA. Findings suggest a pattern of neuropsychological morbidity that is similar but not identical to that seen in adult OSA.

Attention↗